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. 2011 Apr;26(2):78-81.
doi: 10.4103/0972-3919.90256.

Comparative evaluation of 18F-FDOPA, 13N-AMMONIA, 18F-FDG PET/CT and MRI in primary brain tumors - A pilot study

Charu Jora  1 , Jacob J Mattakarottu, Pandit G Aniruddha, Ravina Mudalsha, Dhananjay K Singh, Harish C Pathak, Nitin Sharma, Arti Sarin, Arvind Prince, Giriraj Singh
Affiliations

Comparative evaluation of 18F-FDOPA, 13N-AMMONIA, 18F-FDG PET/CT and MRI in primary brain tumors - A pilot study

Charu Jora et al. Indian J Nucl Med. 2011 Apr.

Abstract

Aim: To determine the diagnostic reliability of 18F-FDOPA, 13N-Ammonia and 18F-FDG PET/CT in primary brain tumors and comparison with magnetic resonance imaging (MRI).

Materials and methods: A total of 23 patients, 8 preoperative and 15 postoperative, undergoing evaluation for primary brain tumors were included in this study. Of them, 9/15 were operated for high grade gliomas (7/9 astrocytomas and 2/9 oligodendrogliomas) and 6/15 for low grade gliomas (5/6 astrocytomas and 1/6 oligodendroglioma). After PET study, 2 of 8 preoperative cases were histopathologically proven to be of benign etiology. 3 low grade and 2 high grade postoperative cases were disease free on 6 months follow-up. Tracer uptake was quantified by standardized uptake values (SUV(max)) and the SUV max ratio of tumor to normal symmetrical area of contra lateral hemisphere (T/N). 18F-FDOPA uptake was also quantified by SUV(max) ratio of tumor to striatum (T/S). Conventional MR studies were done in all patients.

Results: Both high-grade and low-grade tumors were well visualized with 18F-FDOPA PET. Sensitivity of 18F-FDOPA PET was substantially higher (6/6 preoperative, 3/3 low grade postoperative, 7/7 high grade postoperative) than with 18F-FDG (3/6 preoperative, 1/3 low grade postoperative, 3/7 high grade postoperative) and 13N-Ammonia PET (2/6 preoperative, 1/3 low grade postoperative, 1/7 high grade postoperative). FDOPA was equally specific as FDG and Ammonia PET in operated cases but was falsely positive in two preoperative cases. Sensitivity of FDOPA (16/16) was more than MRI (13/16).

Conclusion: 18F-FDG uptake correlates with tumor grade. Though 18F-FDOPA PET cannot distinguish between tumor grade, it is more reliable than 18F-FDG and 13N-Ammonia PET for evaluating brain tumors. 18F-FDOPA PET may prove to be superior to MRI in evaluating recurrence and residual tumor tissue. 13N-Ammonia PET did not show any encouraging results.

Keywords: 13N-Ammonia; 18F-FDG; 18F-FDOPA; MRI; PET; brain tumors; sensitivity.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
A case of operated high grade astrocytoma, with intermittent headache post radiotherapy. Serial MRI showed hematoma at postoperative site. All PET tracers were positive, with best contrast seen on FDOPA PET. This patient expired six months after PET study
Figure 2
Figure 2
A case of high grade astrocytoma with complains of multiple episodes of seizures, post CCRT. Post contrast T1W1 shows mild peripheral enhancement around postoperative gliosis in tight frontal lobe. FDG and ammonia PET are negative. FDOPA shows extensive recurrence with extension in parietal region and pericallosal spread into left frontal lobe. Patient expired two months after PET study
See this image and copyright information in PMC

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